Dissociative Identity Disorder vs. Schizophrenia – Why I was tagged with both

My parents, scared, took me to a therapist a few years after I was attacked as a teen – I had periods of sadness, complete numbness, intense joy and escape in music. And interspersed, periods of irrationality. I found out later I really scared my friends with my mental constructs. I had some sense that my thoughts and actions were very wrong but I was dragged bodily on a roller coaster with no sense of time or space. I didn’t even ponder where the compulsion and agitation came from – I was just there, on a mission to accomplish something I didn’t truly understand and was powerless to control.

The first therapist told my mother that she thought it might be schizophrenia. My mother tells me it drove her on a secret feverish hunt to learn all she could about the frightening disease.

The advances in mental health research and treatment show that symptoms of schizophrenia and dissociative identity disorder are very similar, and DID is often misdiagnosed as schizophrenia. Sometimes people ask for the difference, and I read a paragraph in an article on the Multidimensional Inventory of Dissociation (H-MID) that might help explain it to someone not familiar with the field.

This is based on the work of Schneider (1959) and Kluft (1987), two who have advanced the field significantly.

Schneider listed 11 first-rank symptoms to diagnose schizophrenia:

(1) voices arguing
(2) voices commenting
(3) “made” feelings
(4) “made” impulses
(5) “made” actions
(6) influences playing on the body
(7) thought insertion
(8) thought withdrawal
(9) thought broadcasting
(10) audible thoughts
(11) delusional perception

Kluft (1987) reported the first 8 are common in DID but not the last three. Of the first 8: “[e]ach is a peculiar intrusion into the person’s executive functioning and/or sense of self. ”

The difference is often described this way: those with DID hear voices inside their head; those with schizophrenia hear voices from outside their head. But that is such a sterile descriptor.

I like this one better:

[S]chizophrenics experience psychotic forms of intrusion (e.g., “John Ashcroft is implanting his thoughts in my head.”), whereas dissociative patients experience nonpsychotic intrusions (e.g., “Sometimes I have thoughts that do not feel like they are mine.”).

So those common symptoms – the voices commenting, arguing, etc. At least with DID, all those selves participating or not. Talking when not asked, and silent when input desired. (Although the symptoms are the same, the cause in Schizophrenia is thought to be different.)

Others of the first 8 symptoms are also pretty sterile to the lay person – the idea of “made” feelings, impulses and thoughts.

<That’s from the Sopranos when a top guy is “made.” They all gotta have DID to whacksomeone and then come home with flowers for the wife.>

Ha Ha Ha. Yeahhh. So, moving along, from the Cognitive Therapy of Schizophrenia on “made” symptoms, I find a description of my teenage experiences – compelled to behave inappropriately with no idea why.

Feeling that others or some external agency or force is making you do, think, or feel things – not just psychologically coercing you – must be profoundly disturbing and disempowering.

Back then, I reported feeling controlled by something outside myself. A female entity that was outside me but part of me somehow, and a male entity that was clearly outside me speaking directly (though writings that I still have) to that female entity. I realize now that both were probably voices inside my head. I think. But to a teen, what was the difference? A force outside me was trying mightily to control my thoughts and actions, and often succeeded in his quest to completely control me, and through me, some of my closest friends. I wonder even now, was that truly DID?

i mused and vented before about DID as a psychosis. The only evidence I found was that DID may share some “psychotic-like symptoms” and as such, can lead to an accidental diagnosis of schizophrenia- these symptoms are auditory hallucinations and visual hallucinations. [Dell] However, it is uncommon for these symptoms to be psychotic unless the individual with DID develops “reactive” dissociative psychosis – a true psychotic episode IN ADDITION to DID.

I recall quite vividly several episodes that feel much more than the worst dissociation I feel now. The uncontrollable thoughts and actions I experience now are due to something inside me. Those from my teens clearly were not. I have never admitted it, but have always suspected those were periods of insanity or psychosis.

No wonder they thought I was schizophrenic.

– ∞ –

See also:

List of all posts
Dear Ms. DID: Is someone with DID psychotic, a neurotic, or just mentally unfit?
Meet Emily: the harassing, attention-seeking manipulative stalker and computer-crasher
Review: The Willard Suitcase Exhibit Online

Standard Disclaimer: Read now and again before flaming

References

Dell PF. (2006). A New Model of Dissociative Identity Disorder, Psychiatr Clin N Am, 29 pp 1-26.

Somer E and Dell PF. (2005) Development of the Hebrew-Multidimensional Inventory of Dissociation (H-MID): A Valid and Reliable Measure of Pathological Dissociation, J of Trauma and Dissociation. Vol. 6(1), accessed November 24, 2008 from http://www.somer.co.il/articles/2005H-MID.JTD.pdf.

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10 Comments»

  davidrochester wrote @

My own research would suggest that in addition to dissociation, psychotic breaks are not uncommon after an event of intolerable stress and fear, especially in individuals who are already coping with psychological and emotional trauma.

I think it’s quite likely that something different happened to you in your teen years than you are experiencing now. Props to your mom, btw … obviously she paid some attention and tried to help, and I’ve noticed before on this blog that you talk freely to her about what’s going on with you, yes? Clearly she wasn’t able to protect you as you needed to be in order to stay whole, but it means something that she cared, and still does care.

There is an excellent novel by Antonia White called Beyond the Looking-Glass (I think that’s right) which you might find interesting … it’s based on the author’s own experience of psychotic break, and her experience in a mental hospital at the turn of the century. Her lucidity and ability to remember exactly how the break happened, and how she came back from it, are extraordinary. I suppose it might be triggering to some extent, though I didn’t find it to be … there was actually something rather magical about how she described her own insanity, and her description of emerging from the fog of psychotic delusion is both inspiring and enormously poignant. The book is the third in a series, and all three are exceptional achievements.

  Emily’s Camigwen wrote @

Truly my mom has/is amazing. Back then mental illness was certainly a lot more taboo and I feel bad that she went through her own personal horror about all this. It wasn’t until the last year that we finally got it out on the table and started to heal. But yes, she has been here completely. It is just amazing.

I looked at the book online – Beyond the Glass. Do I need to read the others first or can I start out with this one? I am curious to read what other’s have experienced as a comparison to myself. It is that part of my past I would like to understand much more than recovering the entirety of the attack. That I can do without – but all they fcked up stuff afterwards that I mentioned above – understanding that compulsion then that compels me now to know. (Hows that for both a mental and a physical tongue twister?) A never ending cycle until perhaps I get full understanding. And this understanding I truly want.

Thanks for the reference.

  davidrochester wrote @

I think the third book can be read on its own, though the other two are well worth reading. It’s worth reading if only to see both how far the treatment of mental illness has come … and also how similar it still is to the barbaric practices of nearly a century past.

  behindthecouch wrote @

Hey – can you clarify for one who doesn’t entirely understand yet – is DID generally not considered to include psychosis in list of standard symptoms?

I saw that David says it can, but is the official literature, understanding etc say generally not?

Thanks!

BTC

  Emily’s Camigwen wrote @

BTC- generally not from what I read. Some symptoms are described as “psychotic-like” but the DSM codes for psychoses and DID are in different categories. David probably has some good input as well.

  Jackie wrote @

kudos to your statement David: psychotic breaks are not uncommon after an event of intolerable stress and fear. (yep that pretty much says it ya think?)

  davidrochester wrote @

LOL@ Jackie.

BTC and Emily, I do think that psychotic breaks and dissociative phenomena are two different things which can sometimes co-exist. Having corresponded with and spoken to a number of people who have “gone nuts”, as it were, it seems to me that people not infrequently “come back” from psychotic breaks, whereas they rarely do this spontaneously from severe and chronic dissociation.

  Emily’s Camigwen wrote @

David…and continuing on that thread (in the analysis of my own life…) since I don’t recall either the start or the end of that possible psychotic episode, it could be possible that alters were created during that time. Also, this period of relative normalcy and sort-of nuts interspersed with the periods of irrationality went on for perhaps a year. From what I know now, I can see there was a lot of switching, and from my work with the last therapist, the creation of a couple of alters to protect me, to distract me, and to make sure no one suspected anything.

This will be a major topic in my therapy when I am able to do it. But this intellectualization of the whole thing is very good for me now.

  Jackie wrote @

Seriously.
I don’t have:
a recognizeable place in time that I recall what I “see” as normal,
so I don’t know really what “normal” should
feel like,
be like,
I should think like.
I’ve got so many people,
fragments,
memories running around perhaps I should let McSteamy root around in my head….ok, he can root around other places too…damm fine looking man.
=
the need for T

  Emily’s Camigwen wrote @

Sounds like despite the discontinuities and disconnects, that there is good in there too?


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